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General NPI Number Information
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NPI Number | 1689935306
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA PRIMARY CARE, INC.
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 137 GA HIGHWAY 32 BYP
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City | ALMA
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State | GA
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Zip | 31510-2757
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Country | US
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Telephone | 912-632-8244
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Fax |
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Provider Business Mailing Address
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Address Line | 137 GA HIGHWAY 32 BYP
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City | ALMA
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State | GA
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Zip | 31510-2757
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Country | US
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Telephone | 912-632-8244
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DAVID P GLASS
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Credential |
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Telephone | 912-632-8244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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